Maxillofacial Specialists Research Articles

The role of telemedicine in the management of maxillofacial trauma in emergency departments – preliminary results

New technologies have over the past forty years become widespread across all domains of basic and applied research particularly in health-related fields. Telemedicine is a form of remote medical practice using information and communication technologies. It connects one or more health professionals with other health professionals or with patients. Within the framework of emergencies in maxillofacial surgery, requests received for specialist advice often pertain to procedures to be followed for facial wounds, bites, burns, maxillofacial bone trauma or facial cellulitis. These requests for specialist advice were previously made by phone between emergency physicians and maxillofacial specialists, with exchange of patient photos by text messaging, which raised security issues. We collaborated with the Telehealth Normandy Health Cooperation Group (GCS TSBN) for the implementation of a mobile application using the “Therap-e” telemedicine platform. This platform links together websites and remote health professionals via the Internet. Physicians communicate over a mobile network or from a health institution, in online or offline mode, synchronously or asynchronously, using any medium (tablet, PC, Mac, smartphone). This scheme both ensures secure transmission of personal and clinical data (especially facial photographs) and records specialist advice in patient medical records. The purpose of tele-expertise applications in an emergency context is to provide a solution to the demographic problems facing healthcare professionals and to rise to the growing challenges surrounding quality and security issues.

Application of Convolutional Neural Network in the Diagnosis of Jaw Tumors.

ObjectivesAmeloblastomas and keratocystic odontogenic tumors (KCOTs) are important odontogenic tumors of the jaw. While their radiological findings are similar, the behaviors of these two types of tumors are different. Precise preoperative diagnosis of these tumors can help oral and maxillofacial surgeons plan appropriate treatment. In this study, we created a convolutional neural network (CNN) for the detection of ameloblastomas and KCOTs.MethodsFive hundred digital panoramic images of ameloblastomas and KCOTs were retrospectively collected from a hospital information system, whose patient information could not be identified, and preprocessed by inverse logarithm and histogram equalization. To overcome the imbalance of data entry, we focused our study on 2 tumors with equal distributions of input data. We implemented a transfer learning strategy to overcome the problem of limited patient data. Transfer learning used a 16-layer CNN (VGG-16) of the large sample dataset and was refined with our secondary training dataset comprising 400 images. A separate test dataset comprising 100 images was evaluated to compare the performance of CNN with diagnosis results produced by oral and maxillofacial specialists.ResultsThe sensitivity, specificity, accuracy, and diagnostic time were 81.8%, 83.3%, 83.0%, and 38 seconds, respectively, for the CNN. These values for the oral and maxillofacial specialist were 81.1%, 83.2%, 82.9%, and 23.1 minutes, respectively.ConclusionsAmeloblastomas and KCOTs could be detected based on digital panoramic radiographic images using CNN with accuracy comparable to that of manual diagnosis by oral maxillofacial specialists. These results demonstrate that CNN may aid in screening for ameloblastomas and KCOTs in a substantially shorter time.

An Investigation Into the Disease Profile and Healthcare Costs of Inpatients Treated at a Major Oral and Maxillofacial Surgical Center.

This study is a retrospective review which reported on the treatment records of oral and maxillofacial inpatients treated at a medical institution with the largest scale of oral and maxillofacial specialist services in China, to reflect on disease profile, healthcare model characteristics and the medical status of oral and maxillofacial surgery in China. Information on 25,825 patients hospitalized between 2008 and 2013 was collected to analyze the mean length of stay (LOS) and preoperative LOS, expenditure patterns, and payment status. The overall mean LOS and preoperative LOS were 10.0 ± 4.9 days and 4.3 ± 2.1 days, respectively. The main costs composed of surgery charges and material costs (47.4%). The proportion of nonlocal patients was 76.34% and the majority of patients used their basic medical insurance (57.74%), and the proportion of patients self-paying showed the largest increase over time. Rising charges for inpatients in this institution did not cause an aggravation of medical cost burden of residents. Cost burden of oral and maxillofacial malignancy surgery patients was higher than in developed countries. The overall mean LOS and preoperative LOS were higher than that of similar patients globally. Compared with medicine and material costs, medical income is lower and the value of medical personnel labor is not fully appreciated. The proportion of patients who actually enjoy the benefits of the basic medical insurance in China is lower than the coverage.

Non-syndromic multiple keratocystic odontogenic tumors: An arduous challenge for oral and maxillofacial specialists

Introduction: Keratocystic odontogenic tumor (KOt) is a common developmental odontogenic cyst affecting the maxillofacial region. Multiple odontogenic keratocysts (OKcs) are usually seen in association with nevoid basal cell carcinoma syndrome but approximately only 5% of patients with keratocystic odontogenic tumor have multiple cysts without concomitant syndromic presentation. Only a few cases have been reported till date. case report: this report emphasizes a unique case of a young 14-year-old female suffering since an early age and the role of multidisciplinary approach in the diagnosis and management of a case of multiple keratocystic odontogenic tumors in a non-syndromic patient. conclusion: the non-syndromic KcOts are linked to the expression of a characteristic gene. they are associated with severe morbidity in the younger age group due to their multiple involvement of the jaws but their recurrence rate is less compared to that of syndromic type. the diagnosis and management of these tumors mandates multidisciplinary approach which can instill confidence and improve quality of life of the patients.

Tinnitus in Temporomandibular Joint Disorders: Is it a Specific Somatosensory Tinnitus Subtype?

The most significant otologic symptoms, consisting of ear pain, tinnitus, dizziness, hearing loss and auricolar "fullness", generally arise within the auditory system, often are associated with extra auricolar disorders, particularly disorder of the temporo-mandibular joint. In our study we examined a sample of 200 consecutive patients who had experienced severe disabling symptom. The patiens came to maxillofacial specialist assessment for temporomandibular disorder. Each patient was assessed by a detailed anamnestic and clinical temporomandibular joint examination and they are divided into five main groups according classification criteria established by Wilkes; tinnitus and subjective indicators of pain are evaluated. The results of this study provide a close correlation between the joint pathology and otologic symptoms, particularly regarding tinnitus and balance disorders, and that this relationship is greater the more advanced is the stage of joint pathology. Moreover, this study shows that TMD-related tinnitus principally affects a younger population (average fifth decade of life) and mainly women (more than 2/3 of the cases). Such evidence suggests the existence of a specific tinnitus subtype that may be defined as "TMD-related somatosensory tinnitus".

Double reporting and second opinion in head and neck pathology

This editorial aims to discuss the practice of “double reporting” and “second opinion” diagnosis in routine diagnostic pathology interpretation. It does not encompass reviews performed as part of audit and quality assurance functions, but is from the perspective of experienced head and neck and oral and maxillofacial specialists. “Double reporting” generally refers to showing a case to one or more colleagues working in the same histopathology unit before issuing a malignant diagnosis [1]. When there is concurrence, the fact that the case has been seen by two pathologists may or may not be mentioned in the report, often determined by individual practice, medical-legal environments and relative value units of workload. The final report may be signed by all pathologists who reviewed the case or might simply include a statement that the “case has been reviewed by {name of reviewer(s)}, who concur(s) with the diagnosis”. In case of a major disagreement between experienced pathologists in the same unit (e.g., benign vs. malignant), additional evaluation should be solicited and the issued diagnosis may be a majority decision. This difference of opinion should be mentioned in the report, with typical examples including cases of melanoma or hematopoietic and lymphoid neoplasia. The practice of “double reporting” varies between diagnostic histopathology units worldwide, from non-existent to voluntary to mandatory. Nevertheless, increasing risk from medical litigation may eventually tip the scales towards mandatory double reporting as a standard protocol for subsets of pathology diagnosis, such as malignant lesions. “Double reporting” may also be applied to unusual, rare, and difficult diagnoses, including benign lesions. The variations in practices have made comparisons between institutions difficult, with very little reported literature. Nevertheless, a study involving 45 laboratories in the USA reported a median rate of review of about 1 in 12 cases, with malignancy and difficult diagnosis being the primary reported reasons for review [2]. The study documented that head and neck lesions accounted for 4.1 % of cases with “double reporting”, while three-fifths were focused on gastrointestinal tract, breast, skin and female genital tract lesions [2]. Referring a case for a “second opinion” implies the traditional, formal approach of sending a case to an external, recognized specialist department or individual pathologist with experience and expertise in a particular field. It often involves rare or difficult cases where the referring pathologists are uncertain of the diagnosis, recognize the inherent challenges of the case and regard “second opinion” part of their required/expected diligence in working up and finalizing a diagnosis. Other reasons include the lack of access to required laboratory investigations, tests, or molecular testing to confirm a diagnosis. “Second opinion” may be retrospective when there is an institutional review of outside pathology slides as a standard protocol for referral patients before definitive treatment. A retrospective request for “second opinion” can also be made directly by the patient, relatives or legal representatives. This may occur after investigation into the diagnosis by the patient and is becoming more common with the universal availability of the internet, lay access to medical literature and litigation. Finally, “second opinion” can be retrospectively requested when departmental audit or quality assurance reveals a disagreement between pathologists that cannot be resolved internally. “Second opinion” can account for a significant component of a specialist head and neck/oral and maxillofacial pathologist’s workload. The number of “second opinion” evaluations should be audited when assessing target workloads for individual pathologists.

Facial reconstruction in Ethiopia

In April 2013 I had the opportunity to assist with a facial reconstruction project in Ethiopia. Project Harar is a British charity that provides access to treatment for patients with facial deformities living in rural areas of Ethiopia. Patients with a cleft of the lip and/or palate are the most common group encountered. They are treated by a team of Ethiopian plastic surgeons and health staff throughout the year in the capital, Addis Ababa. Each year, however, the Project Harar community staff are presented with a number of patients with complex facial deformities, the management of which exceeds the level of experience and resources available in Ethiopia. An international surgical team comprising plastic and maxillofacial surgeons, anaesthetists and specialist nurses travels to Ethiopia annually for a two-month period to provide assistance with these complex cases. My role as a junior doctor was to assess the patients in preparation for surgery, organise the necessary investigations and assist in theatre where needed.

The feasibility of using Patients Concerns Inventory (PCI) in managing Malaysian oral cancer patients

The feasibility of using the Patients Concerns Inventory (PCI) to identify oral cancer patient concerns during consultation in oral and maxillofacial specialist clinics in Malaysia was assessed. A cross-sectional study was conducted using a consecutive clinical sampling technique of all new and follow-up oral cancer patients. Surgeons and counter staff were also recruited. Two-thirds of patients were elderly, 63.9% female, 55.6% Indian, 63.9% of lower-level education, and half had the lowest level household income. Patient status was mostly post-treatment (87.5%) and most were at cancer stage III/IV (63.9%); 59.7% had surgery. Patients took an average 5.9min (95% CI 5.1–6.7min) to complete the PCI. Physical domain appeared highest (94.4%); social/family relationship issues (4.2%) were lowest. Significant associations included patient age–personal function (P=0.02); patient education level–emotional status (P=0.05) and social/family relationship issues (P=0.04), and patient TNM staging–personal function (P=0.03). The patients’ mean feasibility score for the PCI was 5.3 (95% CI 5.1–5.5) out of 6. Patients (93.1%) and surgeons (90%) found the PCI to be feasible. Only 57.1% of counter staff agreed on the use of the PCI during patient registration. Overall, the PCI was considered feasible, thus favouring its future use in routine oral cancer patient management.

Nager Acrofacial Dysostosis: A Case Series With Literature Review and Update

pathology by an oral and maxillofacial surgeon or TMJ specialist. Ordinal variables obtained included maximal incisal opening (MIO) at preoperative, 1 month, 3-6 months and 1+ year follow up visits. Secondary variables obtained included prior history of TMJ surgery and incidence of surgical complications. Other variables recorded included age at time of surgery and gender. SPSS statistical software, version 21 was used. Oneway analysis of variance (ANOVA) and non-parametric tests were utilized and statistical significance was set at a p-value of 1year intervals were equivalent (p>0.05). Average improvement in range of motion after 1 year when compared to preoperative values was greater in the DJD group (mean = 8mm increase in MIO) than painless hypomobility/trauma/malocclusion group (mean = 3mm increase in MIO). Interestingly, a prior history of open joint surgery affects mandibular range of motion at all time intervals except 1-month post TJR surgery (p<0.05). The rate of postoperative complications was 58%, although the vast majority were neurologic deficits that recovered by 1-year postoperative.

A potential role for sex hormone receptor antagonists in treatment of malignant salivary gland tumours, as compared to breast cancer: A review of literature

Malignant salivary gland tumours (MSGTs) account for less than 5% of all cancers of the head and neck. However, their treatment represents a challenge to oral and maxillofacial specialists. Surgical resection followed by radiation therapy represents the primary treatment of localized MSGTs. Since breast and salivary glands share similar morphologic features; similarities in the pathological processes are also expected. Adjuvant hormonal therapy is recommended for breast tumours containing hormone receptor protein. The expression of sex hormones in MSGTs, and their potential use in treatment is still controversial. This review article discusses three types of tumours arising in the breast and salivary glands; namely mucoepidermoid carcinoma, adenoid cystic carcinoma and salivary duct carcinoma. The expression of sex hormone receptor proteins and the potential use of hormone receptor antagonists in treatment are also being addressed.

1024PD - Surveillance of Adolescents and Young Adult Patients with Fanconi Anemia (FA): Awareness of Diagnosing Solid Tumors at a Young Age

ABSTRACT Disclosure All authors have declared no conflicts of interest. A great proportion of FA patients reaches adulthood and become at risk for developing secondary malignancies. In 2009, the High Risk and Cancer Prevention Unit (HRCPU) at Hospital Vall d'Hebron started a follow-up program for adolescents and adult patients with FA. The goal was to advocate for prevention measures to reduce cancer risk, and coordinate a multidisciplinary surveillance for different neoplasms. During annual HRCPU visits, FA patients undergo a complete anamnesis and receive health education. The surveillance program includes: hematological follow up with hemograms and bone marrow aspiration; examination for head and neck lesions by an otolaryngologist; detailed examination of the oral cavity by a maxillofacial specialist; semestral gynecologic examinations for women with annual cervical cytology testing and breast examination. Finally, HPV vaccination is encouraged. Since 2009, 14 FA patients have been enrolled in our follow-up program. Overall, 50% were women, and median age was 22 years (14-32). Their mean age at diagnosis of FA was 6.5 years, 57% belonged to FANCA group and 57% underwent a bone marrow transplantation (BMT). Follow up has ranged from 1 month to 3 years, 70% of patients have adhered properly with the program and 83% of women have received HPV vaccination. So far, 4 patients (29%) have been diagnosed with a malignant tumor and another two with a premalignant lesion. Premalignant lesions were found in the oral cavity (hyperplasia with mild dysplasia of the tongue) and gynecological (squamous intraepithelial lesion of the cervix CIN1). From those diagnosed with cancer, two of them had head and neck tumors. One was a lingual squamous cell carcinoma pT2N1M0 diagnosed at 24 years which recurred at 4 years and the patient died at age 30. The patient had received a BMT at age 8. The other one was a squamous cell carcinoma of the epiglottis pT4N1M0 diagnosed at 32 years in a patient with mosaicism. The third and fourth patients have developed several basal cell carcinomas in the jaw and back since age 21 and both had undergone BMT at 7 and 8 years. Head and neck tumors are frequent neoplasms in young adults with FA, regardless prior BMT. We need to reinforce surveillance and prevention strategies to reduce the risk of malignancies in these locations.

Parotid Gland Tumors: A Survey of UK Management Practice

Objective: Identify if practice variations exist in the management of parotid lesions between otolaryngologists and oral maxillofacial specialists (OMFS). Benign and malignant parotid surgery is undertaken by both otolaryngologists and OMFS. Between the specialties there is debate about the surgical approach to parotid tumors. Method: An online questionnaire (SurveyMonkey) was sent to members of ENT-UK via email. The members of the British Association of Oral and Maxillofacial Surgeons (BAOMS) were posted a questionnaire that was either returned by post or completed online. Results: A total of 108 otolaryngologists and 98 OMFS res-ponded to the questionnaire, all of whom performed parotid surgery. The majority (75.2%) of otolaryngologists used facial nerve monitors in all/most cases whereas 73.1% OMFS used them never/seldom. In revision surgery 88.3% of otolaryngologists mostly/always used a facial monitor compared to 38% of OMFS with 39.1% never/seldom using one. The choice of surgery for a presumed pleomorphic adenoma showed the most difference between the two groups: 87.6% of otolaryngologists would perform a partial parotidectomy, yet 34.5% of OMFS would remove the tumor by extracapsular dissection of the tumor without a cuff. Conclusion: There are marked differences in the approach to parotid disease between OMFS and otolaryngologists, particularly in the intra-operative monitoring and the surgical approach.

Development of a Regional Database for Studying Epidemiology of Maxillofacial Trauma

This article discusses the development of the first regional computerized database for the epidemiological evaluation of maxillofacial trauma and tests its usefulness by evaluating the appropriateness and completeness of the resulting information.The database was developed using Microsoft Access, implemented using Visual Basic. Data were entered in the database by 4 different maxillofacial specialists, one from each of the 4 main regional hospitals where maxillofacial trauma is treated. Clinical information was taken from 100 complete records of patients hospitalized for maxillofacial fractures at the Maxillofacial Division of San Giovanni Battista Hospital in Turin from January to June 2009.Thirteen database fields were used: general information, cause and mechanism of injury, fracture site, Facial Injury Severity Scale, head and neck examination, associated injuries, timing and type of surgery, and days of hospitalization.Overall, the data entered were 99.45% complete and 99.5% accurate. Thus, our regional maxillofacial database can be considered complete and accurate. Some of the errors, mainly in the fields "fracture site" and "Facial Injury Severity Scale," were attributable to an incorrect interpretation of facial fracture diagnoses, based on the medical records that were provided.

Health Professional Perspective on Disability in Head and Neck Cancer

To evaluate problems after head and neck cancer (HNC) from the multidisciplinary team perspective; to classify the results using the International Classification of Functioning, Disability, and Health (ICF); and to compare the results with a patient perspective. Internet-based survey. There were 103 participants from 27 countries: 50 physicians (otolaryngologists, maxillofacial specialists, and radiation and medical oncologists) and 53 nonphysicians (dentists, psychologists, physiotherapists, speech swallowing therapists, nurses, and social workers). Health professionals involved in the treatment of HNC were asked about relevant problems. The survey was Internet based and included 5 questions, 1 for each of the ICF components: Body Functions, Body Structures, Activities and Participation, and contextual Environmental and Personal factors. Answers were translated into ICF categories by 2 independent researchers, and frequencies were calculated. The results were compared with the outcomes of patient interviews based on similar questions. A total of 3643 different answers translated into the ICF using 160 different second-level ICF categories. Less than 1% of answers were not covered by the ICF. There was high consistency in the ratings of food ingestion, pain, and the relevance of the immediate family. In general, health professionals tended to emphasize aspects of anatomical defects and body image, whereas areas of speech and exercise tolerance functions were more often named by patients. The ICF seems to be a comprehensive tool for classifying problems after HNC from the multidisciplinary health professional perspective. There are important differences between the health professional and patient perspectives. We should be aware of this during cancer follow-up sessions and in the creation of rehabilitation plans.

Economic aspects of mandibular third molar surgery

Objective. The aim of this study was to make estimates from a dental care and societal perspective on costs of mandibular third molar surgery. Material and methods. A total of 64 patients were recruited from three Swedish oral and maxillofacial specialist clinics. Calculations were made prospectively on utilization of labor time, specific medical services and materials, and standardized utilization of other direct costs. Indirect costs were identified from patient surveys. Results. The base case average direct cost of surgery was 217 Euro. Adding the patient's average cost due to absence from work and transportation of 333 Euro increased overall costs to 550 Euro per patient. About 86% of the patients reported some absence following surgery. Conclusions. The indirect costs were on average higher than the direct costs, i.e. the patient's loss of time caused higher costs than the intervention per se. Appropriate indications for mandibular third molar removal can minimize the risks of complications and individual or societal costs.

Conebeam computed tomography (CBCT): The new vista in oral and maxillofacial imaging

Cone beam computed tomography (CBCT) has the potential to reduce the size and cost of CT scanners. This emerging technology produces images with isotropic sub-millimeter spatial resolution with high diagnostic quality, short scanning times of about 10-30 seconds, and radiation dosages of up to 15 times lower than those of conventional CT scans. It is ideally suited for dedicated dentomaxillofacial CT scanning. This technology provides dental practitioners with complete solution for performing specific diagnostic and clinical tasks, including implant planning, temporomandibular joint evaluation, facial fractures, dentoalveolar surgery, orthognathic surgery and periodontal surgery. CBCT is capable of providing a 3-dimensional representation of the maxillofacial hard tissues with minimal distortion. The objective of this article is to highlight the clinical applications of CBCT to oral and maxillofacial surgeons and other dental specialists in Nigeria.

Patterns of activity for a combined oral and maxillofacial surgery and otolaryngology specialist registrar/SAS grade second on call cross cover rota

Patterns of activity for a combined oral and maxillofacial surgery and otolaryngology specialist registrar/SAS grade second on call cross cover rota

Obstructive sleep disordered breathing in children: Beyond adenotonsillectomy

Traditionally, adenotonsillectomy (AT) has long been the treatment of choice for obstructive sleep disordered breathing (SDB) in children. AT is usually considered a safe procedure, which cures 80% of children with SDB. Accumulated data have however challenged this overly simplistic view. Indeed, AT is invariably associated with significant morbidity, post-operative pain, and a mortality rate which, though low, cannot be ignored. In addition, aside from a recurrence of SDB at adolescence in an unknown percentage of cases, some recent results suggest that complete SDB cure is not achieved in as much as 75% of cases after AT. Interestingly, several treatment options have been recently proposed for replacing or complementing AT. Continuous positive airway pressure (CPAP) is now suggested in children with remaining SDB after AT; however, compliance and suitability of equipment remain important hurdles, especially in small children and infants. Anti-inflammatory treatments, including nasal glucocorticoids and/or the anti-leukotriene montelukast, appear to hold great promise. Finally, orthodontic treatments are an appealing option, with recent results in children suggesting that it is possible to improve or perhaps even cure SDB in a durable manner by enlarging the nasal passages and/or the oropharyngeal airspace. In conclusion, while we are currently in the midst of an exciting time with several new treatments being developed for childhood SDB, randomized controlled trials are urgently needed to delineate their indications. In the meantime, it appears that systematic detection of orthodontic anomalies and better collaboration with maxillofacial specialists, including orthodontists and/or dentists, is needed for deciding the best treatment options for childhood SDB.

Orbital Floor Fractures: Evaluation, Indications, Approach, and Pearls from an Ophthalmologist's Perspective

Blunt trauma to the orbital rim is a frequent cause of orbital floor fractures. Although orbital floor fractures often occur in association with other facial trauma, the term "blowout fracture" is reserved for isolated orbital floor fractures with an intact orbital rim. Many surgical specialties--including ophthalmologists, otolaryngologists, maxillofacial specialists, and plastic surgeons--evaluate and treat floor fractures. The wide range of treating physicians means that varying levels of expertise and experience are involved in care of patients with periorbital trauma. Although each subspecialty can offer pearls from their basis of training, the purpose of this article is to offer insights on orbital floor fractures from the ophthalmic plastic and reconstructive surgeon's perspective. Particular emphasis will be placed on ophthalmic portions of the examination and treatment plan; all in an attempt to avoid ophthalmic complications. This review is meant to be a user-friendly guide to the evaluation and treatment of orbital floor fractures from an ophthalmic perspective.

Trends in maxillofacial cone-beam computed tomography usage

Cone-beam computed tomography (CBCT) is making inroads into dental practice worldwide, both in terms of adding the third dimension to diagnosis, and also in terms of enabling image-guided treatment strategies. This article reports trends in the early referral pattern of patients to a CBCT facility in the United States. With institutional review board approval, a retrospective study was made of sequential CBCT radiographic reports made by a specialist oral and maxillofacial radiology service from May 2004 through January 2006 (n = 329). Demographic and referral data were extracted from the reports. Descriptive statistics identified referral patterns, trends, and indications for CBCT. Comparisons were made with the Rogers' Product Innovation Adoption curve. The mean age of referred patients was 45 ± 21 years, and there was a predominance of women (62%). Oral and maxillofacial surgeons (51%) and periodontology specialists (17%) made most patient referrals. The listed reasons for CBCT referrals were dental implant planning (40%), suspected surgical pathology (24%), and temporomandibular joint analysis (16%). Other uses included planning extraction of impacted teeth and orthodontic assessment. Over the period of the study, the numbers of pathology diagnosis cases remained relatively constant, while adoption of CBCT for dental implant planning followed closely the first three stages of the Rogers' Product Innovation Adoption curve. Alongside this increased CBCT adoption for dental implant planning, there was an associated increased demand for use of DICOM image sets for laser modeling and provision of surgical guides. Diagnosis will probably remain a constant source of referral for CBCT examination by oral and maxillofacial radiologists. Nevertheless, more specialized applications such as laser-guided model fabrication and image-guided surgery are expanding indications for CBCT referrals by dentists and also expanding the horizons of clinical dental practice.